TY - JOUR
T1 - An Ounce of Anticipatory Guidance Is Worth a Pound of Testing
JF - Hospital Pediatrics
JO - hosppeds
SP - 456
LP - 458
DO - 10.1542/hpeds.2014-0230
VL - 5
IS - 8
AU - Hodax, Juanita K.
AU - Koster, Michael P.
Y1 - 2015/08/01
UR - http://hosppeds.aappublications.org/content/5/8/456.abstract
N2 - An ex-full-term, healthy, without birth complications, 6-week-old girl was brought to her pediatrician for a well-child visit and given the following vaccines: diphtheria-tetanus–acellular pertussis, Haemophilus influenzae type b (Hib)–inactivated poliovirus, hepatitis B, and rotavirus. Most vaccine schedules begin at 2 months of age, but they can be given as early as 6 weeks.1 Later that day, the patient developed a fever, and her concerned parents brought her to the emergency department (ED). She was well-appearing, with no other symptoms, and feeding well. In the ED she had a temperature of 38.7°C, initiating a serious bacterial infection (SBI) evaluation. Vital signs were otherwise normal, including normal respiratory rate, and complete physical examination was normal. Studies were performed, including urinalysis, urine culture, complete blood count, blood culture, lumbar puncture with cerebrospinal fluid studies and culture, chest radiograph, and molecular respiratory viral panel.The white blood cell (WBC) count was elevated at 18 000 cells/mm3, with 55% neutrophils and no bands. Urinalysis was negative, cerebrospinal fluid studies showed 3 nucleated cells/mm3, 1 red blood cell/mm3, 53 mg/dL protein, and 56 mg/dL glucose. Based on the elevated WBC count, this patient was excluded from the low-risk category, admitted to the pediatric wards, and started empirically on intravenous ceftriaxone. At 22 hours, the patient’s blood culture resulted positive with Gram-positive cocci suggestive of Staphylococcus. A repeat blood culture was drawn, the patient was continued on antibiotics and hospitalized another night. The final blood culture reported coagulase-negative Staphylococcus spp, clinically determined to be contamination rather than bacteremia. The patient continued to be well-appearing, the repeat blood culture as well as all other tests ultimately resulted negative. The fever was attributed to her recent vaccinations and she was discharged from the hospital with her parents after 60 hours.This case …
ER -